Abstract
Elective abortion is the most commonly performed outpatient surgery in the United States, and by mid-life approximately one third of women will have had an abortion. Despite its prevalence, abortion tends to receive little attention in therapy training programs or continuing education. A search of books by the American Psychological Association reveals only one on the topic of abortion, which is now out of print and no longer available for purchase (Beckman & Harvey, 1998). Even a search on Amazon.com revealed that, of the top 25 books on the topic of abortion, only 1, The Healing Choice (De Puy & Dovitch, 1997), appears potentially useful for therapists. The absence of formal clinical training and the lack of easily accessible information leave mental health professionals significantly vulnerable to the influences of abortion myths that infiltrate public consciousness via personal testimony, religious admonition, and political debate. This vulnerability is heightened by the most recent strategies of those who oppose abortion, strategies that have specifically targeted women's mental health and well-being as a justification to limit access to abortion. Without sufficient knowledge of the facts related to abortion, therapists may perpetuate abortion myths in their practices, unintentionally damaging the very women who seek their help.
Thus, it is a relief that Abortion Counseling: A Clinician's Guide to Psychology, Legislation, Politics, and Competency is on the shelves. Based on their comprehensive review of the literature, authors Rachel Needle and Lenore Walker dispel the widely held notion that abortion causes negative psychological outcomes for women. In addition, the authors challenge the notion of a “post-abortion syndrome” by critiquing the research methods used in studies and demonstrating convincingly that the rare cases of serious emotional difficulties following abortion are due to poor mental health functioning prior to the pregnancy and to women's experiences of violence in the form of childhood sexual abuse, sexual assault, and domestic violence. The authors substantiate the fact that the most common emotional experience following abortion is relief and that feelings of sadness, loss, or guilt following abortion are typically resolved without the need for psychological intervention. This information is helpful for clinicians in recognizing that the treatment of psychological symptoms should focus not on abortion itself, but on the context of women's lives and the difficulties prior to and during the pregnancy.
In addition to the outcome research on abortion, Needle and Walker identify the laws, policies, and practices that can negatively impact abortion experiences for women. They expose the shocking proliferation of “Crisis Pregnancy Centers,” agencies that are staffed by unlicensed, nonmedical personnel whose primary aim is to coerce pregnant women to carry their pregnancies to term. Despite the fact that these centers rely on harmful tactics, such as providing inaccurate and sensationalistic information to scare and shame women to avoid abortion, the centers have received millions of dollars in funding through the Bush administration's compassionate giving plan and are growing in number. Other factors that negatively impact the abortion experience that are essential for clinicians to understand include inaccessibility due to severe restrictions on public funding for women who rely on the government for their health care; parental consent and notification laws based on the assumption that teens in violent and abusive homes will benefit from parental involvement; state-mandated counseling that often includes inaccurate information; state-mandated waiting periods that make it prohibitive for women to obtain the necessary transportation, privacy, and time off from work and may delay the abortion, resulting in both increased health risk and cost; and harassment at abortion medical sites that has escalated to the level of protestors recording license plates and posting pictures and personal information of patients in public forums.
One of the most helpful components of Abortion Counseling is its inclusion of indispensable resource information. In a state-by-state appendix at the end of the book, one can quickly access laws related to abortion, including age requirements, funding, and state-mandated counseling requirements and waiting periods. A variety of online resources are included that dispense essential information about abortion and reproductive decision making, such as the National Abortion Federation (www.prochoice.org), Planned Parenthood (www.plannedparenthood.org), and the National Network of Abortion Funds (www.nnaf.org), an organization that can help raise funding for abortion services for low-income women. The authors also provide a treatment module for postabortion group counseling, as well as basic information about specific abortion procedures, steps for a typical abortion on the day of the appointment, and surgical aftercare instructions.
Despite the importance of this book, there are two limitations that may impede its usefulness for therapists. The first is its readability. Certain sections of the book, such as Chapter 1, “Perspectives for the Mental Health Professional,” were dense, technical, and somewhat difficult to follow. Conversely, some sections of the book, such as of Chapter 3, “Assessing Competency and Decision-Making Skills of the Client,” and Chapter 5, “Gauging Your Client's Emotional Regulation and Good Decision Making,” seemed pedantic, oversimplified, and read much like an introductory textbook. Thus, parts of the book were difficult to read, and the writing was inconsistent in its quality and depth.
The second limitation of the book is related to its packaging. Abortion Counseling is based on the premise that abortion is central to the health of women, families, and communities. Therapists not agreeing with this premise are unlikely to read the book, which is unfortunate because these are the very individuals who need the information most. Also, although the book is about abortion counseling, paradoxically, its major premise is that the majority of mental health professionals providing therapy are unlikely to see clients presenting with symptoms related to abortion (excluding preabortion counseling by workers at centers where abortions are performed). Indeed, had I not been a reviewer of this book, I am not sure I would have been compelled to read it given that, in a decade of clinical practice, I've never worked with a woman who identified abortion as an issue of clinical focus.
Despite these limitations, Abortion Counseling provides essential information not only for therapists, but also for professionals in higher education, advocacy, and public policy. This text can serve as a reference for professionals in other fields, such as health teachers; guidance counselors; faith leaders; primary care physicians; local, state, and national representatives; and judges. Most importantly, the arguments made for the role of safe, legal, accessible abortion in sustaining the mental health of girls and women is powerful; Abortion Counseling has the potential to inspire therapists and others to embrace political activism on behalf of girls, women, and their communities.